Provider Demographics
NPI:1467082669
Name:BREVARD HEARING CENTER OF NORTH CAROLINA PLLC
Entity Type:Organization
Organization Name:BREVARD HEARING CENTER OF NORTH CAROLINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PENCEK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:828-490-8776
Mailing Address - Street 1:236 SPICEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-1343
Mailing Address - Country:US
Mailing Address - Phone:859-753-8812
Mailing Address - Fax:
Practice Address - Street 1:424 S CALDWELL ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3904
Practice Address - Country:US
Practice Address - Phone:828-966-4327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty